Payer PolicyActive
FEIBA® (anti-inhibitor coagulant complex)
EVICORE-MEDICAL_DRUG-F39EE6EE
EviCore by Evernorth
Effective: December 1, 2025
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
FEIBA is authorized only for IV use to treat hemophilia A or B with inhibitors (control/prevention of bleeding, perioperative management, routine prophylaxis) and for treatment of bleeding in acquired hemophilia A (compendial), with all other uses excluded; authorization requires a hematologist/hemophilia specialist prescription or consultation, documented diagnosis/indication and dosing plan, dosing consistent with policy (50–100 units/kg for bleeding/perioperative; 85 units/kg every other day for prophylaxis), and is valid for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Hemophilia A with inhibitors — control and prevention of bleeding episodes (FDA-approved)"
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